Healthcare Claims Analytics Managing Consultant
Job Description
Job Family: Management Consulting Travel Required: Up to 25% Clearance Required: Active Public Trust What You Will Do: We are seeking experienced managers with subject matter expertise in healthcare claims data, including knowledge of validating, loading, processing and analyzing healthcare claims data, preferably a variety of claims (Medicare, Medicaid, VA, Commercial). The role will lead strategy, analytics, and audit initiatives aimed at enhancing payment integrity programs, reducing improper payments, identifying fraud and anomalies, and determining payment trends that inform policy and drive cost savings. The successful candidate will: Serve as a strategic leader and thought partner in claims analytics, payment integrity, and reimbursement policy.
Lead assessments of business and technical requirements for claims audits, post-payment analysis, and payment integrity strategies. Interpret complex healthcare data to identify anomalies, trends, and policy gaps. Translate insights into actionable business requirements and policy recommendations. Stay current on state-level healthcare transformation efforts and industry coding standards.
Oversee development of dashboards, reports, and analytics tools to support improper payment reduction. Apply general coding skills to build scalable solutions and support team members in technical execution.
Direct in-depth data modeling, scenario analysis, claims analytics, or health system performance to inform strategic decisions. Provide hands-on training and mentorship to junior consultants and analysts. Facilitate knowledge transfer, promote continuous improvement, and enhance audit readiness across teams.
Foster a collaborative culture that encourages innovation and career growth. Manage complex client engagements from inception to completion, ensuring high-quality outcomes. Lead business development efforts, including proposal creation and relationship management.
Support internal strategy initiatives, including offering development and community engagement. What You Will Need: Bachelor’s degree from an accredited university; advanced degree preferred (e.
g. , MPH, MHA, MBA, JD, or related). 5+ years of experience in healthcare data analytics, consulting, or claims operations, preferably with a focus on payment integrity, improper payment detection, and claims reimbursement.
3+ years of experience leading teams or projects involving healthcare claims data, medical coding, auditing, or post-payment analysis. Proven ability to translate complex data insights into strategic business requirements and policy recommendations. Demonstrated expertise in state health agencies, Medicare, Medicaid, VA, and healthcare reform initiatives.
Strong financial and quantitative analysis skills, including experience in business case development, scenario modeling, and contract strategy alignment. Proficiency in Power BI, Tableau, and/or Alteryx, with hands-on experience developing dashboards and analytics tools. Excellent written and verbal communication skills, with the ability to lead client engagements, manage expectations, and present findings to diverse stakeholders.
Experience in training and mentoring junior staff, facilitating knowledge transfer, and building team capabilities in claims analytics and payment integrity. Ability to Obtain a Public Trust clearance (US Citizenship required) What Would Be Nice To Have: Master’s or Advanced Degree in Public Health, Health Administration, Business, Law, Data Science, or a related field. Deep understanding of reimbursement methodologies, provider contract structures, and claims processing workflows, including resolution practices and audit strategies.
EWJD3
